Detection of Factors That Influence Preeclampsia in Pregnant

Women

Erlina Hayati

, Husna Sari

, G. F. Gustina Siregar

, Stefani Anastasia S.

, Fitriani

Faculty of Midwifery, Deli Husada Deli Tua Health Institute

Postgraduate of Public Health North Sumatra University

Keywords: Parity, Preeclampsia, Pregnant Woman.

Abstract: Preeclampsia and eclampsia are health problems that require special attention because they are as causes death

of pregnant women and high perinatal. This research type was analytical study with case control design. The

population of this research were all pregnant women who check their womb at Sembiring General Hospital.

The sampling technique used random sampling method. The research sample consisted of 62 pregnant women

consisting of 31 cases and 31 controls in which the case group were pregnant women diagnosed with

preeclampsia and the control group were pregnant women diagnosed with no preeclampsia. Primary data

collection methods obtained through direct interviews with research subjects. The research instruments were

standardized questionnaires. Data analysis used univariate analysis, bivariate with chi-square test and

multivariate analysis with multiple logistic regression tests. The research sample consisted from 31 cases and

31 controls. The results showed that respondents who experienced preeclampsia were 29 people with

abnormal weight gain and among respondents who did not experience preeclampsia there were 33 people with

normal weight gain. Chi square test results obtained p value <0.05, it shows that there was an influence of

weight gain on preeclampsia incidence in pregnant women. Obtained OR = 8.338 means that pregnant women

who have preeclampsia have 8.338 times chance of having abnormal weight gain compared to women who

don't have preeclampsia.

1 INTRODUCTION

Maternal Mortality Rate (MMR) is one indicator to

see the degree of women's health. United Nations

International Children's Emergency Founder

(UNICEF) (2015) states every year nearly 10,000

women die due to pregnancy and childbirth problems.

Preeclampsia is the second cause after bleeding

as specific immediate cause of maternal death, on the

other hand the incidence of eclampsia in developing

countries is around 1 case per 100 pregnancies to 1

case per 1700 pregnancies. In African countries, the

preeclampsia incidence is around 1.8% to 7.1%, in

Nigeria, the prevalence is around 2% to 16.7 and the

cause of preeclampsia is not only caused by one factor,

but many factors that cause preeclampsia and

eclampsia ( S. Shoda et al; Gerda G. Zeeman, ; Lars J.

Vatten & Rolv Skjærven ; M Knight,Osungbade,

2015).

Some experts conclude that women with better

socioeconomic conditions will suffer from

preeclampsia less often, without regard it,

preeclampsia suffered by women from capable family

can still be as severe and life-threatening as eclampsia

that affects women at slums (Carl A. Hubel et al.,

1989; Gordon CS Smith et al., 2002; Baha M Sibai,

2003; James M. Roberts & Hilary S. Gammill, 2005;

Richard J. Levine et al, ; Mary Beth Terry et al., 2016;

Labib Ghulmiyyah & Baha M Sibai, 2012;

Cunningham, 2016).

Risk factors of preeclampsia include age, parity,

weight gain during pregnancy, physical activity and

socioeconomic. Control of risk factors plays an

important role in connection with the preeclampsia

prevention. Early diagnosis of preeclampsia with

careful handling gives good prognosis. Preeclampsia

which is handled too late give the worst impact that is

death for mother and fetus (Chobanian, 2016).

The above data illustrates that the problem of

preeclampsia needs to get attention and good

handling, considering the high prevalence and quite

severe complications and knowledge in the

community that is still lacking in handling the

preeclampsia problem in pregnant women and can get

Hayati, E., Sari, H., Siregar, G., S., S. and Fitriani, .

Detection of Factors That Inﬂuence Preeclampsia in Pregnant Women.

DOI: 10.5220/0009472402550261

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 255-261

ISBN: 978-989-758-460-2

255

a more precise picture then research is needed to know

the factors which influence occurence in pregnant

women.

2 METHODOLOGY

The research type was analytic study with case

control design. The study was conducted from

January to July 2018. The population of this study

were all pregnant women who examined the womb at

Sembiring General Hospital. The sample consisted of

62 pregnant women consisting of 31 cases and 31

controls in which the case group consisted of

pregnant women who were diagnosed with

preeclampsia and control group of pregnant women

who were diagnosed with no preeclampsia.

The sampling technique used random sampling.

Primary data collection methods obtained through the

distribution of questionnaires directly on the research

subjects. The research instruments were standardized

questionnaires. Data analysis used univariate

analysis, bivariate with chi-square test and

multivariate analysis with regression tests multiple

logistics.

The research roadmap is as follows:

Preeclamsia Case

Case Control Design

Research period between

January-July 2018

Research respondent were

determined using Random

Sampling Method

Analitics Study

Inclusion criteria in the case

respondent are:

1 Pregnant woman suffer from

preeclamsia

2. Pregnant women with a

gestational age above 20 weeks

3. pregnant women live in Deli

Serdang district

Inclusion criteria in the control

Sample are :

1. Pregnant women who do not

experience preeclamsia

2. Pregnant women with a

gestational age above 20 weeks

3. Pregnant women live in Deli

Serdang district

Cases respondent : 31 persons

Data collection:

Interview and

Quetionnaire

Data analysis:

Univariate analysis,

bivariate analysis with chy-

square test, and multivariate

analysis with multiple

logistic regression test

Control respondent : 31 persons

Figure 1: Research Roadmap

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

256

3 RESULTS AND DISCUSSION

Table 1: Detection Respondents Data of Factors that

Influence the Preeclampsia Occurrences in Pregnant

Women

Note : Table :

K = Case

C = Control

Total of respondents = 62 Respondents

Based on above table, it can be explained that:

a. age: if 1 is <20 and 2 is> 35 years old 20-35

years old,

b. Parity is given by code 1 Primipara and code

2. Multipara,

c. Income is given code 1 <CMW and code 2

for ≥ CMW,

d. Activity is given code 1 Weight (PAL value

1.70-2.40) and given code 2 for the easy

category (PAL value 1.40-1.69),

e. Weight is given code 1 for not Normal (<7

and> 12kg) and code 2 for normal (7-12 kg).

Physical activity can be grouped into three

groups, namely:

a. Easy (activity types 25% of time is used for

sitting or standing, 75% for standing or

moving) or PAL value 1.40 - 1.69

b. Medium (activity types 40% of time is used

for sitting or standing, 60% for standing or

moving) or PAL value 1.70 - 1.99

c. Weight (activity types 75% time used for

sitting or standing, 25% to stand or move) or

PAL value 2.00 - 2.40

Respondents

PAL

Depends on chair or bed

1,2

Sitting job with little or no choice to

move and little or no reaction

activity

1,4 –

1,5

Sitting job with must move and little

or no reaction activity.

1,6 -

1,7

Standing work

1,8

Intensive reaction activities with a

significant amount (> 3 times a

week)

+ 0,3

Heavy manual work or very active

reaction activities.

2,0-2,4

Questions and data collected are taken based on

the results of data collection such as the respondents’

identities which there are questions namely income,

number of children and weight gain during pregnancy

and physical activity.

Based on the study results note that the majority

of pregnant women who experience preeclampsia

under age 20 and above 35 years old are 29 people

from the study respondents, and those aged 20 to 35

years are 10 respondents. Respondents with income

above City Minimum Wage (CMW) are 20 people.

While the majority of pregnant women who do not

experience preeclampsia are age 20 to 35 years old,

as many as 24 people and with an income above the

CMW, as many as 16 people.

The results obtained data that the majority of

pregnant women who experience preeclampsia with

abnormal weight gain where pregnant women have

weight gain below 7 kg and above 12 kg are 38

people, while the majority of pregnant women who

do not experience preeclampsia with normal weight

gain where the mother pregnant who have weight

gain between 7 to 12 kg are 24 people.

It is also known from the study results that age

and income variables do not affect the preeclampsia

incidence. If we look at the age variable, it is known

that among respondents who experienced

Detection of Factors That Inﬂuence Preeclampsia in Pregnant Women

257

preeclampsia there were 17 mothers with age under

20 years or over 35 years and among respondents who

did not experience preeclampsia were 23 mothers

with ages 20-35 years.

The woman reproductive age is 20 to 35 years.

It is the safest period for pregnancy and childbirth

because at that age the risk of complications during

pregnancy is lower. Age less than 20 years and above

35 years are also referred as high-risk age to

experience complications during pregnancy. At the

age less than 20 years, the uterus size has not reached

the normal size for pregnancy, so the possibility of

disruption in pregnancy such as preeclampsia

becomes greater. At the age over 35 years, it occurs

degenerative processes that results structural and

functional changes in peripheral blood vessels that are

responsible for changes in blood pressure, so they are

more vulnerable to experiencing preeclampsia

(Gafur, 2011).

If we see income variable, based on the study

results there is no difference between mothers with

income ≥ CMW and mothers with income <CMW in

their influence toward preeclampsia incidence, it is

possible because high and low income does not

guarantee what kind of food will be consumed by

pregnant women and depends on the frequency of

eating and other factors.

Physical activity does not significantly

influence the preeclampsia incidence. The study

results indicate that among respondents who

experienced preeclampsia there are 21 mothers with

strenuous physical activity and among respondents

who do not experience preeclampsia there are19

mothers with easy physical activity.

Based on the study results, it can be assumed

that easy and heavy activities do not affect the

preeclampsia incidence for pregnant women. It may

be due to physical activity experienced by pregnant

women is difficult to measure by using questionnaire

and observation needs to be done so that in this study

found how physical activities carried out daily during

pregnancy.

Physical activity does not significantly

influence the preeclampsia incidence. The study

results indicate that among respondents who

experienced preeclampsia there are 21 mothers with

strenuous physical activity and among respondents

who do not experience preeclampsia there are19

mothers with easy physical activity.

From the research, it is known that weight

gain affects the preeclampsia incidence. The results

showed that among respondents who experienced

preeclampsia with abnormal weight gain there were

22 thousand cases and 7 mothers of controls and

among respondents who did not experience

preeclampsia with normal weight there were 9 people

from cases and 24 people from controls.

Table 2: Analysis Results of Multiple Logistic Regression

Test

Variable

Sig.

Exp (B)

95% CI

Age

0,72

0,273

2,060

0,566-

7,494

Parity

1,40

0,026

4,087

1,181-

14,139

Physical

Activity

0,22

0,746

1,252

0,322-

4,869

Weight

Gain

1,67

0,019

5,310

1,323-

21,306

Constant

1,98

0,001

0,137

Age

0,70

0,285

2,015

0,557-

7,287

Parity

1,43

0,022

4,200

1,225-

14,399

Weight

Gain

1,77

0,005

5,896

1,698-

20,479

Constant

1,92

0,001

0,146

Parity

1,46

0,019

4,328

1,271-

14,742

Weight

Gain

1,95

0,001

7,067

2,120-

23,557

Constant

1,76

0,002

0,171

After it is done multivariate analysis, it was

found that there were four research variables that

entered the candidates, namely age, parity, physical

activity and weight gain. The most dominant variable

influence the preeclampsia incidence in pregnant

women at Sembiring Hospital was weight gain, which

has Exp B value of 7.067 meaning that pregnant

women who experience preeclampsia had chance of

7.067 times having abnormal weight gain compared

to pregnant women who did not experience

preeclampsia.

The data is presented in the table below:

Table 3: The Effect of Weight Gain on the Preeclampsia

Incidence

Weight

Gain

Preeclampsia Incidence

value

(95

CI)

Cases

Control

Abnormal

Normal

71,0

29,0

22,6

77,4

0,001

8,6

Total

100

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

258

The cross tabulation analysis results of weight

gain toward the preeclampsia incidence obtained that

among respondents who experienced preeclampsia

were 22 people (71.0%), mothers with abnormal

weight gain and among respondents who did not

experience preeclampsia were 24 people (77.4%)

mothers with normal weight gain. Chi square test

results obtained p value <0.05, it showed that there

was effect of weight gain on the preeclampsia

incidence in pregnant women at Sembiring General

Hospital. It is obtained OR = 8.338 means that

pregnant women who have preeclampsia have 8.3381

chance of having an abnormal weight gain compared

to women who don't have preeclampsia.

One of the abnormal weight gain risk for

pregnant women is preeclampsia (E. R. Hillesund et

al., 2018; Ernawati et al., 2018; Jovian M Wat et al.,

2018; Y Sherf et al., 2019).

Preeclampsia is estimated occur in five percent

pregnancies and it usually appears after 20 weeks'

gestation. It is more common in the first pregnancy.

If preeclampsia has occurred, prevention efforts are

made so that it doesn’t become more severe. Disease

recognition and antenatal testing play important role

in avoiding death and the possible risk factors.

(Octaviana Yoseffin, 2011; Jennifer A. Hutcheon et

al, 2018; Lisa M. Bodnar et al, 2018; Marianne

Lønnebotn et al, 2018; Argyro Syngelaki et al, 2019).

Multivariate analysis was performed to analyze

the effect of independent variables on the

characteristics of pregnant women (age, parity and

income), physical activity and weight gain with

dependent variables (preeclampsia events) at

Sembiring General Hospital. Multivariate analysis

used multiple logistic regression analysis. Before

conducting multivariate analysis, the selection of

variables which will become candidates for the

multivariate model is done first. Variables that

become multivariate candidates are independent

variables with p values <0.25 in bivariate analysis. It

is known that from five variables, three of them

should be included as model candidates, namely

parity, activity and weight gain toward the

preeclampsia incidence in pregnant women.

Table 4: Selections of Model Candidates for

Multivariate Modelling Phase

Variable

p value

Age

0,038*

Parity

0,005*

Income

0,440

Activity

0,042*

Weight Gain

< 0,01*

After multivariate analysis, it was found that

there were four research variables that entered the

candidates, namely age, parity, physical activity and

weight gain. The most dominant variable influence

the preeclampsia incidence in pregnant women at

Sembiring General Hospital is weight gain, which has

an Exp B value of 7.067 meaning that pregnant

women who experience preeclampsia have chance of

7.067 times having abnormal weight gain compared

to pregnant women who did not experience

preeclampsia.

After multivariate analysis, it was found that

there were four research variables that entered the

candidates, namely age, parity, physical activity and

weight gain. The most dominant variable influence

the preeclampsia incidence in pregnant women at

Sembiring General Hospital is weight gain, The

percentage correct value obtained 74.2% means age,

parity, physical activity, and weight gain variables

explain the effect on the preeclampsia incidence in

pregnant women at Sembiring General Hospital as

much as74.2%, while the remaining 25.8% is

influenced by other factors which are not included in

this research variable.

Variables that are proven did not have effect on

the preeclampsia incidence namely age, income and

physical activity, it is recommended:

a. It is hoped that the government and relevant

agencies review existing programs by

emphasizing the importance of ANC (Ante Natal

Care) counseling to primigravida pregnant

women for early detection of the preeclampsia

risk and how to prevent it early

b. It is hoped that health workers will be more

active in providing health education to pregnant

women to increase understanding about

preeclampsia dangers, especially for

primigravida mothers and pregnant women with

abnormal weight gain to periodically carry out

pregnancy checks and conduct special

examinations (laboratory tests) routinely such as

blood and urine tests so that they can be detected

early. If abnormalities are found related to the

maternal pregnancy condition, especially to

monitor maternal blood pressure and other

examinations to monitor the preeclampsia

symptoms so that immediate action can be taken

if problems are found related to maternal

pregnancy, besides that it is needed to keep blood

pressure within normal limits during pregnancy

and how to prevent it from an early age by

regulating the weight of pregnant women to stay

in ideal conditions and still maintain adequate

and balanced nutrition.

Detection of Factors That Inﬂuence Preeclampsia in Pregnant Women

259

c. For further researchers are expected to conduct

further research to find out other variables that

are thought as the influence of preeclampsia

occurrence.

4 CONCLUSIONS

It can be concluded that variable which is

proven to influence the preeclampsia incidence is

weight gain. Referring to the frequency distribution

of weight gain respondents, study results showed the

majority of pregnant women who experience

preeclampsia with abnormal weight gain.

a. Variables that are proven influence the

preeclampsia incidence are parity and weight

gain.

b. Variables that are proven do not have effect on

preeclampsia incidences are age, income and

physical activity.

c. Weight gain is proven become the most

influential factor on preeclampsia incidence in

pregnant women with Exp B value of 7.067 (95%

CI; 2.120-23.557) which means pregnant women

who have preeclampsia have 7.067 times chance

to experience excess weight gain compared to

pregnant women who do not experience

preeclampsia.

Chi square test results obtained p value

<0.05, it shows that there is an effect of weight gain

on the preeclampsia incidence in pregnant women at

Sembiring General Hospital. It is obtained OR =

8.338 means that pregnant women who have

preeclampsia have 8.3381 chance for having an

abnormal weight gain compared to women who don't

have preeclampsia.

ACKNOWLEDGEMENT

This research was supported by Health Institut of Deli

Husada Deli Tua, Health Institut of Medistra Lubuk

Pakam, Sembiring General Hospital Foundation, and

Grand Medistra Indonesia.

REFERENCES

Bodnar, L. M., Himes, K. P., Abrams, B., Parisi, S. M., &

Hutcheon, J. A. 2018. Early-pregnancy weight gain and

the risk of preeclampsia: A case-cohort study.

Pregnancy hypertension, 14, 205-212.

Cuningham, F. G. 2016. Obstetri william. Alih Bahasa:

Andry Hartono, Joko Suyono, Brahm U. Pendit.

Jakarta: ECG.

Denantika, O., Serudji, J., Revilla, G. 2015. Hubungan

Status Gravida dan Usia Ibu terhadap Kejadian

Preeklamsia di RSUP Dr.M. Djamil Padang. Jurnal

Kesehatan Andalas, diakses tanggal 10 Juni 2016

;http://jurnal.fk.unand.ac.id.

Dian, O., Serudji, J., Revilla, G. 2015. Hubungan Status

Gravida dan Usia Ibu terhadap Kejadian Preeklamsia di

RSUP Dr.M. Djamil Padang. Jurnal Kesehatan

Andalas, diakses tanggal 20 Juni 2017

;http://jurnal.fk.unand.ac.id.

Dennysantoso, 2016 Memilih Makanan Sehat Untuk

Masyarakat, 2011, Diakses tanggal 10 Februari 2016;

http//www.blogspotdennysantoso.com.

Departemen Kesehatan Republik Indonesia. Profil

Kesehatan Provinsi Sumatera Utara Tahun 2018.,

Medan.

Departemen Kesehatan Republik Indonesia. Profil

Kesehatan Provinsi Sumatera Utara Tahun 2019.,

Medan

Departemen Kesehatan Republik Indonesia. Profil

Kesehatan Provinsi Sumatera Utara Tahun 2019.,

Medan.

Depkes RI, 2018, Hipertensi Penyebab Kematian Nomor

Tiga. Kementerian Kesehatan.RI.Jakarta.-

http://www.depkes.go.id/index.php/-berita/press-

release/810-

Derek Lewellyn-jones, Dasar-dasar obstetric dan

ginekologi, Alih bahasa;Hadyanto, Ed.6 Jakarta,

Ernawati, E., Erliana, E., Sulistono, A., Joewono, H. T.,

Akbar, M. A., Wicaksono, B., ...& Etika, R. 2018. 53.

Expectant management of severe preeclampsia in a

developing country: Maternal outcomes and perinatal

survival. Pregnancy Hypertension, 13, S19.

Erliana, E., Sulistono, A., Joewono, H. T., Akbar, M. A.,

Wicaksono, B., ...& Etika, R. 2018. 53. Expectant

management of severe preeclampsia in a developing

country: Maternal outcomes and perinatal survival.

Pregnancy Hypertension, 13, S19

Fajarwati Paramitasari. 2017. Hubungan antara gaya hidup

selama masa kehamilan dan kejadian preeklamsia di

Puskesmas Waru Sidoarjo, The Indonesian Journal Of

public Health Universitas Airlangga Surabaya.Vol.8 :

122-125

Gafur, A., Nurdin, A., Ramadhany, S., & Rahim, M. R.

2017. Hubungan antara primigravida dengan

preeklampsia. Makassar: Universitas Hasanuddin.

Ghulmiyyah, L., & Sibai, B. 2016, February. Maternal

mortality from preeclampsia/eclampsia.In Seminars in

perinatology (Vol. 36, No. 1, pp. 56-59). WB Saunders.

Gonçalo Miguel Peres, Melissa Mariana and Elisa Cairrão,

Januari 2018. Pre-Eclampsia and Eclampsia: An Update on

the Pharmacological Treatment Applied in Portugal

Hillesund, E. R., Seland, S., Bere, E., Sagedal, L. R.,

Torstveit, M. K., Lohne-Seiler, H., ...& Øverby, N. C.

2018. Preeclampsia and gestational weight gain in the

Norwegian Fit for Delivery trial. BMC research notes,

11(1), 282.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

260

Hubel, C. A., Roberts, J. M., Taylor, R. N., Musci, T. J.,

Rogers, G. M., & McLaughlin, M. K. Lipid

peroxidation in pregnancy: new perspectives on

preeclampsia. American journal of obstetrics and

gynecology, 161(4), 1025-1034.

Hutcheon, J. A., Stephansson, O., Cnattingius, S., Bodnar,

L. M., Wikström, A. K., & Johansson, K. 2018.

Pregnancy weight gain before diagnosis and risk of

preeclampsia: a population-based cohort study in

nulliparous women. Hypertension, 72(2), 433-441.

Knight, M. Eclampsia in the united kingdom 2016. BJOG:

An International Journal of Obstetrics & Gynaecology,

114(9), 1072-1078.

Levine, R. J., Lam, C., Qian, C., Yu, K. F., Maynard, S. E.,

Sachs, B. P., ... & Karumanchi, S. A. 2006. Soluble

endoglin and other circulating antiangiogenic factors in

preeclampsia.New England Journal of Medicine,

355(10), 992-1005.

Lønnebotn, M., Natvig, G. K., Benediktsdóttir, B., Burgess,

J. A., Holm, M., Jógi, R., ...& Franklin, K. A. 2018.

Polycystic ovary syndrome, body mass index and

hypertensive disorders in pregnancy.Pregnancy

hypertension, 11, 32-37.

Osungbade, K. O., & Ige, O. K. 2016. Public health

perspectives of preeclampsia in developing countries:

implication for health system strengthening. Journal of

pregnancy, 2016.

Rachael Fox , Jamie Kitt, Paul Leeson, oktober 2019.

Preeclampsia: Risk Factors, Diagnosis, Management,

and the Cardiovascular Impact on the Offspring.

Risthiana, D. 2016. Hubungan Antara PreeklampsiaBerat

dengan Asfiksia Neonatorum di RSUD Ponogoro per 1

Januari 2017-31 Desember 2017

Roberts, J. M., & Gammill, H. S. 2016. Preeclampsia:

recent insights. Hypertension, 46(6), 1243-1249.

Sherf, Y., Sheiner, E., Shoham Vardi, I., Sergienko, R.,

Klein, J., & Bilenko, N. 2019. Like mother like

daughter: low birth weight and preeclampsia tend to

reoccur at the next generation. The Journal of Maternal-

Fetal & Neonatal Medicine, 32(9), 1478-1484.

Sibai, B. M. 2017. Diagnosis and management of

gestational hypertension and preeclampsia.Obstetrics

& Gynecology, 102(1), 181-192.

Sutrimah, Mikbakhuddin, Wahyuni. D, 2014 .Faktor-

Faktor yang Berhubungan dengan Kejadian

Preeklamsia pada Ibu Hamil di Rumah Sakit Roemani

Muhammadiyah Semarang.

Syngelaki, A., Sequeira Campos, M., Roberge, S., Andrade,

W., & Nicolaides, K. H. 2019. Diet and exercise for

preeclampsia prevention in overweight and obese

pregnant women: systematic review and meta-analysis.

The Journal of Maternal-Fetal & Neonatal Medicine,

32(20), 3495-3501.

Smith, G. C., Stenhouse, E. J., Crossley, J. A., Aitken, D.

A., Cameron, A. D., & Connor, J. M. 2016. Early

pregnancy levels of pregnancy-associated plasma

protein a and the risk of intrauterine growth restriction,

premature birth, preeclampsia, and stillbirth. The

Journal of Clinical Endocrinology & Metabolism,

87(4), 1762-1767.

Sohda, S., Arinami, T., Hamada, H., Yamada, N.,

Hamaguchi, H., & Kubo, T.

1997.Methylenetetrahydrofolate reductase

polymorphism and pre-eclampsia.Journal of medical

genetics, 34(6), 525-526.

Sutrimah, Mikbakhuddin, Wahyuni. D, 2014 .Faktor-

Faktor yang Berhubungan dengan Kejadian

Preeklamsia pada Ibu Hamil di Rumah Sakit Roemani

Muhammadiyah Semarang.

Syngelaki, A., Sequeira Campos, M., Roberge, S., Andrade,

W., & Nicolaides, K. H. 2019. Diet and exercise for

preeclampsia prevention in overweight and obese

pregnant women: systematic review and meta-analysis.

The Journal of Maternal-Fetal & Neonatal Medicine,

32(20), 3495-3501.

Tamher S, 2017 Kesehatan Usia Lanjut dengan Pendekatan

Asuhan Keperawatan, Salemba Medika, Jakarta.

Terry, M. B., Perrin, M., Salafia, C. M., Zhang, F. F.,

Neugut, A. I., Teitelbaum, S. L., ...& Gammon, M. D.

2017. Preeclampsia, pregnancy-related hypertension

and breast cancer risk. American journal of

epidemiology, 165(9), 1007-1014.

Tina Fajarwati Paramitasari. 2017. Hubungan antara gaya

hidup selama masa kehamilan dan kejadian

preeklamsia di Puskesmas Waru Sidoarjo, The

Indonesian Journal Of public Health Universitas

Airlangga Surabaya.Vol.8 : 122-125

Trijatmo Rachimhadbi .2016. Preeklamsia dan

Eklaamsia Jakarta:Yayasan Bina Pustaka Sarwono

Prawiroharjo.

Vatten, L. J., & Skjærven, R. 2016. Is pre‐ eclampsia more

than one disease?.BJOG: An International Journal of

Obstetrics & Gynaecology, 111(4), 298-302.

Wat, J. M., Hawrylyshyn, K., Baczyk, D., Greig, I. R., &

Kingdom, J. C. 2018. Effects of glycol-split low

molecular weight heparin on placental, endothelial, and

anti-inflammatory pathways relevant to

preeclampsia.Biology of reproduction, 99(5), 1082-

1090.

Wati, Risthiana, D. 2016. Hubungan Antara

PreeklampsiaBerat dengan Asfiksia Neonatorum di

RSUD Ponogoro per 1 Januari 2017-31 Desember 2017

Yoseffin, O. 2017.Correlations of Chronic Periodontitis

with Preeclampsia and Fetal Birth Weight.Indonesian

Journal of Obstetrics and Gynecology.

Zeeman, G. G., Fleckenstein, J. L., Twickler, D. M., &

Cunningham, F. G. 2015. Cerebral infarction in

eclampsia.American journal of obstetrics and

gynecology, 190(3), 714-720.

zoseffin, O. 2017.Correlations of Chronic Periodontitis

with Preeclampsia and Fetal Birth Weight.Indonesian

Journal of Obstetrics and Gynecology.

Detection of Factors That Inﬂuence Preeclampsia in Pregnant Women

261